MEDICARE: LOURDES HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385HR2065X	Child Physical Disabilities Respite Care	637453-1	NY

General Provider Information

NPI Number	:	1780013318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOURDES HOSPITAL

Provider Business Mailing Address
First Line	:	1496 RANDOLPH RD
Second Line	:
City	:	GREAT BEND
State	:	PA
Zip	:	18821-9516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1496 RANDOLPH RD
Second Line	:
City	:	GREAT BEND
State	:	PA
Zip	:	18821-9516
Country	:	US
Telephone Number	:	607-760-1280
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	HEATHER TIFFANY BROWN
Credential	:
Telephone Number	:	607-760-1280

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	11/04/2013

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Directions to “LOURDES HOSPITAL ” Practice Location

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